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DIPHTHERIA
Diphtheria is an acute childhood
infectious disease caused by
toxigenic strains of Corynebacterium
diphtheriae. Diphtheria particularly
affects children aged 1 to 5 and
some time up to 15 years

Causative Agent
Diphtheria is caused by a bacteria
Corynebacterium diphtheriae. it is a
gram-positive bacteria. Four types of
diphtheria bacilli are differentiated -
gravis, mitis, belfanti and intermedius,
all are pathogenic to human being

How it spreads
The source of infection may be a case or
carrier:
(i) CASE : patients may be clinical or
subclinical . Mild cases having no more than a
mere running nose or sore throat
 (ii) CARRIER : Carriers are common sources
of infection, their ratio is estimated to be 95
carriers for 5 clinical cases

How it spreads
 Mode of transmission is –
 Droplet infection.
 Direct contact
 Indirect contact
 Unless treated, the period of infectivity may vary from
14 to 28 days from the onset of the disease, but carriers
may remain infective for much longer periods

Incubation Period
The incubation period of
diphtheria is 2 to 6 days.
Some times it may be longer

Sign and symptoms
Diphtheria may affect nasal, pharyngeal or
laryngeal mucosa and patient usually have
 Sore throat,
 Difficulty in swallowing, and
 Low grade fever
throat may show mild erythema, localized
exudate, or a pseudo-membrane.

Sign and symptoms
The pseudo membrane may be a patch on
the posterior pharynx or tonsil. it may cover
the entire tonsil, or, less frequently, may
spread to cover the soft and hard palates and
the posterior portion of the pharynx. In the
early stage the pseudo-membrane may be
whitish and may wipe off easily.

Sign and symptoms
Later the membrane may become thick, blue-
white to grey-black, and adherent. Attempts to
remove the membrane result in bleeding.
Patients with severe disease may have
marked oedema of the submandibular area
and the anterior portion of the neck, along with
lymphadenopathy

Sign and symptoms
Distant toxic damage, it may damage heart
muscle, liver, kidneys, and adrenals,
sometimes accompanied by gross
haemorrhage.
Irregularities of cardiac rhythm indicate
damage to the heart.

Sign and symptoms
 Later, there may be difficulties with vision,
speech, swallowing, or movement of the arms
or legs.
The toxin also produces nerve damage,
resulting often in paralysis of the soft palate,
eye muscles, or extremities

Sign and symptoms
Some times Non-respiratory diphtheria may
affect mucus memberane of the conjunctiva
and genitals and skin lesions.
 The presenting skin lesion is often an ulcer
that may be surrounded by erythema and
covered with a membrane.

Diagnostic
Investigation
Presence of sign and symptoms are
suggestive of diphtheria.
Nasal/oral sab for bacteriological
examination to confirm the diagnosis.
Open sore sample can also be tested in
case of cutaneous diphtheria.

Treatment
Antitoxin is helpful to counter the
effects of toxin.
Antibiotics are also prescribed to kill
bacteria present in tissues. Penicillin
and erythromycin are drugs of choice

Control and
prevention
 The best control measures for diphtheria
are notifications and isolation of patient
for infective period.
There is effective vaccine against
diphtheria that is available in combination
vaccines as DPT or pentavalent vaccine

Control and
prevention
 health education regarding routine
immunization is important in
prevention of diphtheria as vaccine
against diphtheria is included in
national immunization schedule in
India.

Control and
prevention
Concurrent disinfection: Of all articles in
contact with patient and all articles soiled
by discharges of patient .
Terminal disinfection: Of all articles in
contact with patient and unit should be
disinfected after discharge of the patient.

Control and
prevention
Management of contacts: All close
contacts should have cultures taken from
nose and throat and be kept under
surveillance for 7 days. a 7–10 day course
of erythromycin (PO, 40 mg/kg/day for
children and 1 gram/day for adults) is
recommended for all persons with
household exposure to diphtheria

By – SURESH KUMAR ( Nursing Tutor )